Healthcare Provider Details

I. General information

NPI: 1407282908
Provider Name (Legal Business Name): BERNICE OKAFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11459 197TH ST
SAINT ALBANS NY
11412-2842
US

IV. Provider business mailing address

11459 197TH ST
SAINT ALBANS NY
11412-2842
US

V. Phone/Fax

Practice location:
  • Phone: 347-251-9940
  • Fax:
Mailing address:
  • Phone: 347-251-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: